The RAND Center to Improve Care of the Dying will generate a new Developmental Center for Evaluation and Research in Patient Safety: the Center for Patient Safety at the End of Life. The Center will be led by Dr. Joanne Lynn and will build on experts from RAND Health, the Institute for Healthcare Improvement, The Veterans Health Administration, Kaiser Permanente, and other organizations. These leaders in health services research and quality improvement are committed to making care safe and reliable for persons with serious eventually fatal chronic illness, staring with those with advanced chronic heart or lung failure. Although they have the potential to affect the health care provided to all Americans, medical errors and other lapses in patient safety disproportionately affect the oldest and sickest of patients, both in their incidence and in the severity of the consequences. Serious, long-term illness occurs mostly at the end of life-leading to more errors, adverse effects, and erratic and unsafe treatment patients in a population that is most in need of safe, reliable, coordinated care. Seriously ill patients are often subjected to a repeated series of mistakes, including: non-treatment of pain, delirium, and other symptoms; routine discontinuity within and among provider programs; location of care for provider convenience, rather than efficiency or family support; and a lack of focus on advance care planning. The Center aims to help improve the reliability of health care dramatically, by building capacity for improvement through effective change methods and knowledge about safe and correct care of individuals with chronic heart failure of chronic obstructive pulmonary disease. During Phase I, the Center will build a strong team, develop ties to health delivery systems, produce educational materials, and develop a proposal for at least one pilot study that it will carry out during Years 2 and 3. In Phase II, the Center will implement the pilot study(ies), present educational materials, and develop a dissemination for pilot study findings.